Elizabeth Hernandez submitted claims for genetic tests, DME that weren't needed and telemedicine visits that never occured

MIAMI—A Florida woman was sentenced to 20 years in prison for her role in a scheme to defraud Medicare by submitting more than $192 million in claims for genetic tests and durable medical equipment that patients did not need and telemedicine visits that never occurred. 

According to court documents and evidence presented at trial, Elizabeth Hernandez, 45, of Miami, signed thousands of orders for medically unnecessary orthotic braces and genetic testing for Medicare beneficiaries she never spoke to, examined or treated. As part of the scheme, telemarketing companies would contact Medicare beneficiaries to convince them to accept orthotic braces and genetic tests and would then send pre-filled orders for these products to Hernandez, who signed them, attesting that she had examined or treated the patients. However, she had never spoken with many of the patients, and she often had others, including non-licensed individuals, sign her name to fraudulent orders. Hernandez also falsified information in the orders about beneficiaries’ symptoms and injuries. 

During the period of the conspiracy, Hernandez ordered more cancer genetic tests for Medicare beneficiaries than any other provider in the nation. In 2020, when Medicare expanded its telemedicine coverage in response to the COVID-19 pandemic, Hernandez also billed Medicare for thousands of telemedicine visits she never performed, routinely billing over 24 hours of telemedicine in a single day. Hernandez personally pocketed approximately $1.6 million in the scheme, which she used to purchase expensive cars, jewelry, home renovations and travel.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,400 defendants who collectively have billed federal health care programs and private insurers more than $27 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at justice.gov/criminal-fraud/health-care-fraud-unit.